A clinical nursing rotation transforms medical students' interprofessional attitudes.

This study explores the extent to which a one-week nursing rotation for medical students changed the interprofessional attitudes of the participating nurses and students. Third-year medical students worked with nurses before starting clinical rotations. Pre- and post-experience surveys assessing perceptions of mutual respect, nurse-doctor roles, and interprofessional communication and teamwork were given to 55 nurses and 57 students. The surveys consisted of qualitative questions and a Likert scale questionnaire that was analyzed using qualitative and quantitative content analyses. The response rate was 51/57 (89%) students and 44/55 (80%) nurse preceptors. Nurses reported that students met nurses' expectations by displaying responsibility, respect, effective communication, and an understanding of nursing roles. Medical students' narratives demonstrated two significant changes. First, their views of nurses changed from that of physician helpers to that of collaborative patient-centred professionals. Second, they began defining nursing not by its tasks, but as a caring- and communication-centred profession. Responses to Likert-scaled questions showed significant differences corresponding to changes described in the narrative. A one-week immersive clinical nursing rotation for medical students was a transformative way of learning interprofessional competencies. Learning in an authentic workplace during a clinical rotation engendered mutual respect between nurses and future doctors. Students' view of the role of nurses changed from nurses working for doctors with patients, to working with doctors for patients.

Developing self-assessment skills amongst doctors in Nepal.

BACKGROUND: Accurate self-assessment is essential to direct life-long learning. Most research on self-assessment is from the West. This study takes place in Kathmandu, Nepal. AIM: To develop tools to aid the development of self-assessment skills in Nepali doctors. METHODS: Fifteen doctors were asked to complete three self-assessment tasks per month over a 6-month period; one mini-clinical evaluation exercise, one clinical case review and one significant event analysis. Self-assessment was compared with mentor assessment for each task. Changes over time for each individual were noted. Results were analyzed using SPSS 10.0. Self and tutor scores were compared using Pearson's correlation coefficient. Reliability of the tools was assessed using Cronbach's Alpha. Participants completed a qualitative questionnaire regarding each tool. RESULTS: All three tools had high content and face validity, as well as reliability. The use of the "intra individual" approach, with multiple assessments over time demonstrated that most doctors were able to accurately self-assess in some areas. Feedback from a senior tutor was vital. Doctors appreciated feedback that was immediate, specific and delivered in a safe environment. Even where self-assessment was less accurate, the process itself helped to develop awareness of key learning issues. CONCLUSIONS: These self-assessment tools are feasible, reliable and valid for the hospital setting in Nepal.

Retention of general practitioners in rural Nepal: a qualitative study.

OBJECTIVES: To explore the key issues that influence GP retention in rural areas of Nepal. DESIGN: A qualitative study using triangulation of data from one postal questionnaire, one hand-delivered questionnaire with semistructured interview and focus group discussions. Data from a small community survey from 13 rural districts also included. PARTICIPANTS: Sixty-two Nepali GPs, 25 doctors in General Practice training programs, 11 individuals involved in policy development and rural health care. RESULTS: The key issues identified by this study as critical to the retention of Nepali GPs in rural areas were: * Career/promotion prospects * Status/recognition * Financial incentives * Working conditions * Education for children * Continuing medical education * Political stability and security. CONCLUSIONS: The strongest theme was that of career development. This must be addressed by the Government of Nepal if there is to be any hope of improving retention of GPs in rural areas. GPs need to have a clear career ladder, with recognition of the value of service in rural areas. There is, however, no one single answer to the complex interacting factors that impact on GP retention in rural Nepal. A multifaceted, holistic response is necessary. From the level of community awareness, a career structure and financial remuneration to adequately set up hospitals, functional teams, family support, continuing professional development and a secure working environment - each area must be addressed for the whole to function.